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Decortication is performed under general anaesthesia. It is a major thoracic operation that has traditionally required a full thoracotomy . Since the early '90s this procedure has increasingly been performed using more minimally invasive thoracoscopy .
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. [1] It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine (the latter may be necessary to access tumors in the spine).
The flap allows for 1) passive drainage of the pleural space and 2) negative pressure to develop in the thoracic cavity due to it being easier for air to escape than to enter the chest. The lung can then expand to the chest wall and seal the inner opening of the flap. [3] Other surgeons have subsequently proposed modifications to the procedure. [6]
Video-assisted thoracoscopic surgery (VATS) is a type of minimally invasive thoracic surgery performed using a small video camera mounted to a fiberoptic thoracoscope (either 5 mm or 10 mm caliber), with or without angulated visualization, which allows the surgeon to see inside the chest by viewing the video images relayed onto a television screen, and perform procedures using elongated ...
A resuscitative thoracotomy is indicated when severe injuries within the thoracic cavity (such as hemorrhage) prevent the physiologic functions needed to sustain life.The injury may also affect a specific organ such as the heart, which can develop an air embolism or a cardiac tamponade (which prevents the heart from beating properly).
The prognosis after surgical decortication is variable and depends on the health of the underlying lung before the procedure takes place. [3] If the lung was otherwise healthy, then certain aspects of lung function, such as vital capacity , may improve after decortication. [ 3 ]
Surgical pleurodesis, also known as mechanical or abrasive pleurodesis, may be performed via thoracotomy or thoracoscopy.This involves mechanically irritating the apical and the costal pleura, often with a scratchpad (a small foam pad with coated abrasive) normally used for cleaning electrocautery blade tips.
It was further developed by Hans Christian Jacobaeus, a Swedish internist in 1910 for the treatment of tuberculous intra-thoracic adhesions. He used a cystoscope to examine the thoracic cavity, developing his technique over the next twenty years. Today, thoracoscopy is performed using specialized thoracoscopes.